While the Quatuor trial is still underway, some AIDS clinicians in France have already begun to lighten their patients’ prescriptions. Such a possibility is consistent with Article 8 of the French Code of Medical Ethics and was confirmed in May 2017 by the National Council for AIDS and Hepatitis (CNS). The organisations remained cautious, however: Any such change requires a rigorous medical follow-up, with close biological examinations of the patient.
The continuing dominance of the daily treatment regime may be explained by resistance to change – which is not unique to physicians – and by the difficulty of questioning established rules within the medical community. Other factors can play a role as well, including the caution of patients and physicians, as well as doctors’ fear of lawsuits.
Another factor is the influence of the pharmaceutical industry. After all, four days of treatment rather than seven represents 42 percent reduction in medication. If expanded throughout France, such a treatment program would result in a savings of some 500 million euros each year (based on 100,000 patients on treatment, with an average monthly cost per patient of 1,000 euros). Beyond reducing costs nationally, reduced treatment frequency could also increase the availability of antiretroviral treatments to those currently not being treated, particularly in the developing world.
An additional trial, called “big ICCARRE”, also led by Dr. Leibowitch, is exploring the possibility of that HIV treatment can safely be reduced to three, two or even one day per week, while maintaining a controlled viral load in patients. The objective is to find the medical dosage that is both necessary and sufficient for each patient, and is in accordance with the phrase often attributed to Hippocrates, “First do no harm”.